Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Orthopaedics, Linqing City People's Hospital, Linqing, China.
Orthop Surg. 2021 Apr;13(2):376-383. doi: 10.1111/os.12737. Epub 2021 Jan 22.
Wrist reconstruction after en bloc resection of bone tumors of the distal radius has been a great challenge. Although many techniques have been used for the reconstruction of long bone defects following en bloc resection of the distal radius, the optimal reconstruction method remains controversial. This is the first review to systematically describe various reconstruction techniques. We not only discuss the indications, functional outcomes, and complications of these reconstruction techniques but also review the technical refinement strategies for improving the stability of the wrist joint. En bloc resection should be performed for Campanacci grade III giant cell tumors (GCT) as well as malignant tumors of the distal radius. However, wrist reconstruction after en bloc resection of the distal radius represents a great challenge. Although several surgical techniques, either achieving a stable wrist by arthrodesis or reconstructing a flexible wrist by arthroplasty, have been reported, the optimal reconstruction procedure remains controversial. The purpose of this review was to investigate which reconstruction methods might be the best option by analyzing the indications, techniques, limitations, and problems of different reconstruction methods. With the advancement of imaging, surgical techniques and materials, some reconstruction techniques have been further refined. Each of the techniques discussed in this review has its advantages and disadvantages. Wrist arthrodesis seems to be preferred over wrist arthroplasty in terms of grip strength and long-term complications, while wrist arthroplasty seems to be superior to wrist arthrodesis in terms of wrist motion. All things considered, wrist arthroplasty with a vascularized fibular head autograft might be a good option because of better wrist function, acceptable grip strength, and a relatively lower complication rate. Moreover, wrist arthrodesis is still an option if the fibular head autograft reconstruction fails. Orthopaedic oncologists should familiarize themselves with the characteristics of each technique to select the most appropriate reconstruction method depending on each patient's situation.
桡骨远端骨肿瘤整块切除后的腕关节重建一直是一个巨大的挑战。虽然已经有许多技术用于整块切除桡骨远端后的长骨缺损重建，但最佳的重建方法仍存在争议。这是第一篇系统描述各种重建技术的综述。我们不仅讨论了这些重建技术的适应证、功能结果和并发症，还综述了改善腕关节稳定性的技术改进策略。整块切除应适用于 Campanacci 分级 III 级骨巨细胞瘤（GCT）和桡骨远端恶性肿瘤。然而，桡骨远端整块切除后的腕关节重建仍然是一个巨大的挑战。虽然已经报道了几种手术技术，包括通过关节融合实现稳定的腕关节或通过关节置换重建灵活的腕关节，但最佳的重建方法仍存在争议。本综述的目的是通过分析不同重建方法的适应证、技术、局限性和问题，探讨哪种重建方法可能是最佳选择。随着影像学、手术技术和材料的进步，一些重建技术得到了进一步的改进。本综述讨论的每种技术都有其优缺点。在握力和长期并发症方面，腕关节融合似乎优于腕关节置换，而在腕关节活动度方面，腕关节置换似乎优于腕关节融合。综合考虑，带血管腓骨头自体移植的腕关节置换可能是一个不错的选择，因为它具有更好的腕关节功能、可接受的握力和相对较低的并发症发生率。此外，如果腓骨头自体移植重建失败，腕关节融合仍然是一种选择。矫形肿瘤学家应该熟悉每种技术的特点，根据每个患者的情况选择最合适的重建方法。
